In the case of ingested substances, do not inducevomiting in a patient who is not awake and alert. Forspecific treatment of ingested substances, refer to thesection on poisons in chapter 5.There are numerous other psychiatric conditionsthat would require volumes to expound upon. Inalmost all cases, appropriate first aid treatmentconsists of a calm, professional, understandingdemeanor that does not aggravate or agitate the patient.With an assaultive or hostile patient, a show of forcemay be all that is required. Almost all cases ofpsychiatric emergencies will present with a thirdparty]often the family or friend of the patientwhohas recognized a distinct change in the behaviorpattern of the patient and who is seeking help for them.DERMATOLOGIC EMERGENCIESMost dermatologic cases that present asemergencies are not real emergencies. The patientperceives them as such because of the suddenpresentation and/or repulsive appearance or excessivediscomfort. Treat most dermatologic conditionss y m p t o m a t i c a l l y. T h e m a j o r e x c e p t i o n t osymptomatic treatment is toxic epidermal necrolysis(TEN).Toxic epidermal necrolysis is a conditioncharacterized by sudden onset, excessive skinirritation, painful erythema (redness of skin producedby congestion of the capillaries), bullae (largeblisters), and exfoliation of the skin in sheets. TEN isalso known as the scalded skin syndrome because ofits appearance. TEN is thought to be caused by astaphylococcal infection in children and by a toxicreaction to medications in adults.Since skin is the largest single organ of the bodyand serves as a barrier to infection, prevention ofsecondary skin infection is very important. Treatmentof skin infections consists of isolation techniques,silver nitrate compresses, aggressive skin care,intravenous antibiotic therapy and, in drug-inducedcases, systemic steroids.EMERGENCY CHILDBIRTHEvery Hospital Corpsman must be prepared tohandle the unexpected arrival of a new life into theworld. If the Corpsman is fortunate, a prepackagedsterile delivery pack will be available. This pack willcontain all the equipment needed for the normaldelivery of a healthy baby. If the pack is not available,a Hospital Corpsman will require imaginativeimprovisation of clean alternatives.When faced with an imminent childbirth, theHospital Corpsman must first determine whether therewill be time to transport the expectant mother to ahospital. To help make this determination, theCorpsman should try to find outif this will be the womans first delivery (firstdeliveries usually take much longer thansubsequent deliveries);the time between contractions (if less than 3minutes, delivery is approaching);if the mother senses that she has to move herbowels (if so, then the babys head is welladvanced down the birth canal);if there is crowning (bulging) of the orifice(crowning indicates that the baby is ready topresent itself); andhow long it will take to get to the hospital.The Corpsman must weigh the answers to thesequestions and decide if it will be safe to transport thepatient to the hospital.Prior to childbirth, a Corpsman must quickly setthe stage. The mother must not be allowed to go to thebathroom since straining may precipitate delivery. Donot try to inhibit the natural process of childbirth. Themother should lie back on a sturdy table, bed, orstretcher with a folded sheet or blanket placed underher buttocks for absorption and comfort. Remove allthe patients clothing below the waist, bend the knees,move the thighs apart, and drape her lower extremitieswith clean towels or sheets. Don sterile gloves, or, ifthese are not available, rewash your hands.In a normal delivery, your calm professionalmanner and sincere reassurance to the mother willreduce her anxiety and make the delivery easier foreveryone. Help the woman rest and relax as much aspossible between contractions. During a contraction,deep, open-mouth breathing will relieve some pain andstraining. As the childs head reaches the area of therectum, the mother will feel an urgent need to defecate.Reassurance that this is a natural feeling and a sign thatthe baby will be born soon will help alleviate herapprehension.Watch for the presentation of the top of the babyshead. Once the head appears, take up your station atthe foot of the bed and gently push against the head tokeep it from emerging too quickly. Allow it to come4-70